학술논문
Preoperative biliary drainage in severely jaundiced patients with pancreatic head cancer: A retrospective cohort study.
Document Type
Academic Journal
Author
van Gils L; Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands. Electronic address: laj.van.gils@meandermc.nl.; Verbeek R; Department of Gastroenterology and Hepatology, Groene Hart Hospital, Gouda, the Netherlands.; Wellerdieck N; Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands.; Bollen T; Department of Radiology, St. Antonius Hospital, Nieuwegein, the Netherlands.; van Leeuwen M; Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands.; Schwartz M; Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort, the Netherlands.; Vleggaar F; Department of Radiology, St. Antonius Hospital, Nieuwegein, the Netherlands.; Molenaar IQQ; Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands; Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.; van Santvoort H; Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands; Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.; van Hooft J; Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands.; Verdonk R; Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands.; Weusten B; Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, the Netherlands.
Source
Publisher: Elsevier Country of Publication: England NLM ID: 100900921 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1477-2574 (Electronic) Linking ISSN: 1365182X NLM ISO Abbreviation: HPB (Oxford) Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Guidelines recommend against preoperative biliary drainage (PBD) in patients with pancreatic head cancer if bilirubin levels are <250 μmol/l. However, patients with higher bilirubin levels undergo PBD, despite the lack of supporting evidence. This study aims to evaluate outcomes in patients with a bilirubin level ≥250 and < 250.
Methods: Patients were identified from databases of 3 centers. Outcomes were compared in patients with a bilirubin level ≥250 versus <250 both at the time of diagnosis and directly prior to surgery.
Results: 244 patients were included. PBD was performed in 64% (123/191) with bilirubin <250 at diagnosis and 91% (48/53) with bilirubin ≥250. PBD technical success (83% vs. 81%, p = 0.80) and PBD related complications (33% vs. 29%, p = 0.60) did not differ between these groups. Analyzing bilirubin levels ≥250 versus <250 directly prior to surgery, no differences in severe postoperative complications and mortality were found.
Conclusions: In patients with a pancreatic head cancer, PBD technical success and complications, and severe postoperative complications did not differ between patients with a bilirubin level ≥250 and < 250. Our study does not support a different approach regarding PBD in patients with severe jaundice.
(Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
Methods: Patients were identified from databases of 3 centers. Outcomes were compared in patients with a bilirubin level ≥250 versus <250 both at the time of diagnosis and directly prior to surgery.
Results: 244 patients were included. PBD was performed in 64% (123/191) with bilirubin <250 at diagnosis and 91% (48/53) with bilirubin ≥250. PBD technical success (83% vs. 81%, p = 0.80) and PBD related complications (33% vs. 29%, p = 0.60) did not differ between these groups. Analyzing bilirubin levels ≥250 versus <250 directly prior to surgery, no differences in severe postoperative complications and mortality were found.
Conclusions: In patients with a pancreatic head cancer, PBD technical success and complications, and severe postoperative complications did not differ between patients with a bilirubin level ≥250 and < 250. Our study does not support a different approach regarding PBD in patients with severe jaundice.
(Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.)